DRAM is a separation of the connective tissue joining the two strips of muscles down the middle of the abdomen. When you are pregnant, the abdominal wall muscles and their connective tissue attachments stretch to accommodate the growing foetus. DRAM occurs when the linea alba, the connective tissue joining the two rectus abdominus muscles, widen and splits. This separation can affect the stability of the trunk and may contribute to pelvic floor dysfunction, back and pelvic pain during pregnancy and post-natally.
DRAM can have a number of implications for the post natal woman. Alterations of the muscle’s angle of insertion will change the muscles function. Changes in rectus abdominis length, width and angle of insertion seen after delivery, which are associated with a reduction in the ability to stabilise the lumbopelvic area (Gilleard & Brown, 1996). A separation persisting after 4 weeks post-natally is likely to disrupt the function of the abdominal musculature. This may be a factor in persistent post natal lumbar, pubic symphysis and sacroiliac pain and even incontinence due to interaction of the pelvic floor and abdominal musculature as a stabilising unit.
Treatment consists of retraining the action of the various layers on the abdominal wall. It is crucial the exercise program does not further compromise the abdominal wall. Exercising too strongly or in an incorrect way can further increase DRAM. A sit up is a poor way of improving abdominal muscle function after delivery.
DRAM is a separation of the connective tissue joining the two strips of muscles down the middle of the abdomen. When you are pregnant, the abdominal wall muscles and their connective tissue attachments stretch to accommodate the growing foetus. DRAM occurs when the linea alba, the connective tissue joining the two rectus abdominus muscles, widen and splits. This separation can affect the stability of the trunk and may contribute to pelvic floor dysfunction, back and pelvic pain during pregnancy and post-natally.
DRAM can have a number of implications for the post natal woman. Alterations of the muscle’s angle of insertion will change the muscles function. Changes in rectus abdominis length, width and angle of insertion seen after delivery, which are associated with a reduction in the ability to stabilise the lumbopelvic area (Gilleard & Brown, 1996). A separation persisting after 4 weeks post-natally is likely to disrupt the function of the abdominal musculature. This may be a factor in persistent post natal lumbar, pubic symphysis and sacroiliac pain and even incontinence due to interaction of the pelvic floor and abdominal musculature as a stabilising unit.
Treatment consists of retraining the action of the various layers on the abdominal wall. It is crucial the exercise program does not further compromise the abdominal wall. Exercising too strongly or in an incorrect way can further increase DRAM. A sit up is a poor way of improving abdominal muscle function after delivery.
An assessment of your abdominal wall post-natally by a Physiotherapist particularly using a real-time ultrasound will be able to give you an idea of how well your abdominal area is recovering. Starting some particular exercises that your Physio prescribes you will ensure you get your stomach muscles working again without compromising further separation. We also recommend our patients wear SRC Recovery Shorts which we now stock in the clinic. They will provide gentle compression to your abdominal muscles. This level of compression stimulates your muscles to be continuously active which encourages them to come back together and heal.
If you have any questions about regaining your stomach muscle function following childbirth then please don’t hesitate to speak to a SquareOne Physio. We even have a specialist Women’s Health Physio, Megan Dunphy, for those with complex issues.
